Lower Limb Asymmetry and Patellofemoral Joint Incongruence in the Etiology of Knee Exertion Injuries in Athletes

Kujala, U. M.; Friberg, O; Aalto, Teuvo; Kvist, M; Osterman, K

doi:10.1055/s-2008-1025658

Cited by 51 publications

(32 citation statements)

References 28 publications

(37 reference statements)

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“…Leg length differences were suggested to be related to one's efficiency (Delacerda & McCrory, 1981). Additionally, LLI and knee pathology were significantly correlated in an investigation by Kujala, Friberg, Aalto, Kvist, & Osterman (1987) on lower limb malalignment and knee exertion injuries in male athletes with and without knee injuries.…”

Section: Geometric/anthropometricmentioning

confidence: 95%

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Effects of Fatigue on Bilateral Ground Reaction Force Asymmetries during the Squat Exercise

Hodges

Patrick

Reiser

2011

Journal of Strength and Conditioning Research

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OF THESIS EFFECTS OF FATIGUE ON BILATERAL GROUND REACTION FORCE ASYMMETRIES DURING THE SQUAT EXERCISEPhysical performance and risk for injury have been related to functional asymmetries of the lower extremity. The squat exercise is an important, functional movement serving as the major multi-joint, closed-chain lower extremity exercise in many strength and conditioning programs, as well as a large component in rehabilitation.Examinations of asymmetries during the squat exercise have revealed bilateral differences in the net joint torques, indicating unequal actions between the lower extremities. To date, no study has examined how fatigue affects these asymmetries. PURPOSE:The goal of this investigation was to examine functional bilateral asymmetries of the lower extremities during the squat exercise, exploring how they may change during the course of an individual set, as well as across multiple sets with fatigue.Based on a review of literature related to the effects of fatigue on functional asymmetries, it was hypothesized that asymmetries would increase with fatigue. METHODS:Seventeen recreationally trained men (n=9) and women (n=8) (mean ± SD age: 22.3 ± 2.5 yrs; height 170 ± 9.3 cm; mass 73.4 ± 13.8 kg) performed five sets of eight repetitions with 90% of their predetermined eight-repetition maximum (8RM 113 ± 35 % of their body mass). Anthropometric measurements and vertical ground reaction force (GRFv) data were collected. GRFv asymmetries were calculated by subtracting the % load on the iv right foot from that of the left foot. Initially highly symmetric subjects (± 1.7%) were removed from the analyses. The first two (R1&2) and last two (R7&8) repetitions of each set were examined. Eight subjects were reassessed for repeatability measures. RESULTS:R7&8 took longer to complete than R1&2 within a single set (p<0.001), however this finding was not observed across sets (p=0.867). The average asymmetry level across all sets for the absolute average was 4.3 ± 2.5% and 3.6 ± 2.3% for R1&2 and R7&8, respectively. There was no difference in whole group analysis (n=17) for any of the GRFv asymmetry analyses. Initially symmetric subjects were removed for the following analyses. For absolute peak instantaneous forces, the average asymmetry level across all sets was 3.8 ± 2.3% and 3.2 ± 2.3% for R1&2 and R7&8, respectively. Within a set, based on absolute asymmetry, levels of asymmetry dropped from beginning to end of a set (p=0.044). Exploring general shifts towards the left or right leg revealed a significant difference in peak instantaneous asymmetry with subjects becoming more symmetric with fatigue during the course of a single set (p=0.042). Of those who placed more weight on their right side at the beginning of a set, based on average asymmetry, a significant movement towards symmetry was seen for repetitions within a single set (p=0.036). Anthropometrics (segment lengths and circumferences) were generally not highly correlated to the asymmetries. Anthropometric measures were highly repeatable (Cronbac...

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Section: Geometric/anthropometricmentioning

confidence: 95%

“…When jumping, the longer limb, more often, was determined to be the preferred takeoff leg, which helped to elucidate the relationship between LLI and knee exertion injuries (Kujala et al, 1987).…”

Section: Geometric/anthropometricmentioning

confidence: 99%

Effects of Fatigue on Bilateral Ground Reaction Force Asymmetries during the Squat Exercise

Hodges

Patrick

Reiser

2011

Journal of Strength and Conditioning Research

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“…4,26,40 Excessive foot pronation during gait is accompanied by internal rotation of the tibia resulting in increased valgus stress at the knee. 26 Injuries related to tensile forces at the medial knee are a logical sequela, 9,13,22,34,40 while degenerative conditions resulting from increased compressive stress at the lateral knee may also occur. 26 Kujala et al 34 reported that a group of athletes with a limb length inequality greater than 5 mm had a statistically significant increase in overuse knee injuries compared to a control group with no limb length inequality.…”

Section: Pathologies Related To Limb Length Inequalitymentioning

confidence: 99%

“…Radiographs from 200 cm were more accurate (0-3 mm) than from 100 cm. Kujala et al 34 studied the effect of varying the vertical height of the tube focal point when imaging the entire lower extremity. The X-ray beam was first centered over the femoral heads and images were taken.…”

Section: Radiographymentioning

confidence: 99%

Limb Length Inequality: Clinical Implications for Assessment and Intervention

Brady¹,

Dean²,

Skinner³

et al. 2003

J Orthop Sports Phys Ther

156

101

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The purpose of this paper is to review relevant literature concerning limb length inequalities in adults and to make recommendations for assessment and intervention based on the literature and our own clinical experience. Literature searches were conducted in the MEDLINE, PubMed, and CINAHL databases. Limb length inequality and common classification criteria are defined and etiological factors are presented. Common methods of detecting limb length inequality include direct (tape measure methods), indirect (pelvic leveling), and radiological techniques. Interventions include shoe inserts or external shoe lift therapy for mild cases. Surgery may be appropriate in severe cases. Little agreement exists regarding the prevalence of limb length inequality, the degree of limb length inequality that is considered clinically significant, and the reliability and validity of assessment methods. Based on correlational studies, the relationship between limb length inequality and orthopaedic pathologies is questionable. Stronger support for the link between low back pain (LBP) and limb length inequality is provided by intervention studies. Methods involving palpation of pelvic landmarks with block correction have the most support for clinical assessment of limb length inequality. Standing radiographs are suggested when clinical assessment methods are unsatisfactory. Clinicians should exercise caution when undertaking intervention strategies for limb length inequality of less than 5 mm when limb length inequality has been identified with clinical techniques. Recommendations are provided regarding intervention strategies. J Orthop Sports Phys Ther. 2003;33:221-234.

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“…This lack of attention to bilateral rearfoot angle differences is surprising given that asymmetrical rearfoot alignment has been associated with limb length discrepancies 2 and that bilateral asymmetry in lower limb structural measures has been implicated in the etiology of knee pathologies. 3,5,9,16,23,25 For example, it has been suggested that structural variations between the lower limbs may cause a more asymmetrical and inconsistent running pattern, leading to substantial differences in the magnitude of the impact load experienced by each limb during activities such as running. In such instances, the limb experiencing the higher load may be the more likely to be injured.…”

mentioning

confidence: 99%

Bilateral Rearfoot Asymmetry and Anterior Knee Pain Syndrome

Livingston

Mandigo²

2003

J Orthop Sports Phys Ther

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Study Design: Single-session observational study. Objectives: To examine the magnitude and extent of asymmetry between right and left rearfoot angles in individuals who are asymptomatic versus symptomatic for anterior knee pain. Background: Asymmetry in lower limb measures has been linked to the occurrence of knee pathologies, yet the practice of deriving unilateral rather than bilateral data and thereafter averaging the findings may play a role in obscuring the true nature of the rearfoot angle-knee pain relationship. Methods and Measures:A convenience sample of participants was recruited from the local university and business communities and a university-affiliated physiotherapy clinic. Eighty-one young adult males and females volunteered to participate in this study. Following an extensive screening process, including mandatory exclusion for a previous history of lower limb dysfunction or injury, data were collected from 75 individuals classified as asymptomatic (n = 50), unilaterally symptomatic (n = 11), or bilaterally symptomatic (n = 14) for anterior knee pain. Right and left rearfoot angles were goniometrically measured under static, weight-bearing conditions. Results: No significant differences in mean right and left rearfoot angles by group or limb were observed. However, these mean values did not always reflect the true variation of data within the sample. Fifty-six percent of the individuals studied demonstrated a minimum of 4°bilateral rearfoot angle difference, while for 20% of the sample this difference exceeded 7°. Only a weak yet statistically significant correlation existed between right and left rearfoot angles (r = 0.31, PϽ0.01). Conclusions: Rearfoot angles in weight bearing are not bilaterally symmetric, and the magnitude and direction of the observed asymmetry does not appear to be indicative of whether an individual is asymptomatic or symptomatic for anterior knee pain. J Orthop Sports Phys Ther. 2003;33:48-55.

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Lower Limb Asymmetry and Patellofemoral Joint Incongruence in the Etiology of Knee Exertion Injuries in Athletes

Cited by 51 publications

References 28 publications

Effects of Fatigue on Bilateral Ground Reaction Force Asymmetries during the Squat Exercise

Effects of Fatigue on Bilateral Ground Reaction Force Asymmetries during the Squat Exercise

Limb Length Inequality: Clinical Implications for Assessment and Intervention

Bilateral Rearfoot Asymmetry and Anterior Knee Pain Syndrome

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